Clin Res Cardiol (2021)

Gender-specific outcome and risk factors for worse prognosis in patients undergoing transcatheter mitral valve repair for severe mitral regurgitation
K. Diehl1, R. Osteresch1, A. Ben Ammar1, P. Dierks1, S. Rühle1, A. Fach1, J. Schmucker1, H. Wienbergen1, R. Hambrecht1
1Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen;

Background: Knowledge regarding gender-specific results of transcatheter mitral valve repair (TMVR) is scarce and gender-specific risk factors for worse clinical outcome are rarely available.
Objective: The study sought to investigate gender differences in outcomes and to evaluate gender-specific risk factors for worse prognosis in patients undergoing TMVR for severe mitral regurgitation (MR).
Methods: Consecutive patients with severe MR treated with TMVR were enrolled. Baseline clinical and invasive hemodynamic variables, changes in echocardiographic parameters and New York Heart Association (NYHA) functional class, periprocedural and in-hospital major adverse events were assessed. Primary endpoint was defined as a composite of all-cause mortality and re-hospitalization for heart failure during a median follow-up period of 13 ± 10 months. A multivariable Cox-proportional hazard regression analysis was performed to identify gender-related independent predictors for primary endpoint.
Results: 244 women (Age: 76.4 ± 9.1 years) and 350 men (Age: 75.8 ± 8.9 years) underwent TMVR for severe MR. Male patients had significantly higher Logistic EuroSCORE (27.9 ± 13 % vs. 18.0 ± 12 %, p<0.001), higher creatinine levels (2.5 ± 0.9 mg/dl vs.1.5 ± 0.7mg/dl; p<0.001) and showed higher rates of coronary artery disease (49.2 vs. 72.2 %, p<0.001). Regardless of gender the rate of successful MR reduction (MR <2+) by TMVR was high and also similar in both groups with low periprocedural and in-hospital major adverse event rates. All-cause mortality and rehospitalization due to congestive heart failure 30 days after TMVR was equal in both groups (3.2 % vs. 6.3 %; p=0.13; 6.9 % vs. 9.4 %; p=0.48, respectively). At long-term follow-up, Kaplan-Meier analysis revealed significant lower event-free survival for combined primary endpoint in men (56.5 % vs. 47.4 % ;log-rank p=0.03) with higher hospitalization rates in men compared to women (40.7 % vs. 29.5 %; p=0.01). In Cox regression analysis higher NT-proBNP levels (hazard ratio (HR) 1.21; 95% confidence interval (CI) 1.13 - 1.25; p=0.01), NYHA functional Class IV prior to TVMR (HR 2.44; 95% CI 1.1 - 5.36; p=0.03) and a reduced pulmonary artery pulsatility index (PAPi; HR 0.8, 95% CI 0.69 - 0.95; p=0.01) were independent predictors for combined primary outcome in women, whereas a reduced left ventricular cardiac power index (LVCPi; HR 0.63; 95% CI 0.46 - 0.87; p=0.004), higher creatinine levels (HR 1.97; 95% CI 1.37 - 2.83; p<0.001), preexisting pulmonary disease (HR 1.81; 95% CI 1.05 - 3.27; p=0.048) and diabetes mellitus (HR 2.26; 95% CI 1.28 - 3.99; p=0.005) were independent predictors for primary endpoint in men.
Conclusions: Regardless of gender TMVR is associated with immediate success and low in-hospital major adverse events rates. Men showed higher rates of rehospitalization at long-term follow-up. Different gender-specific risk factors for worse prognosis were observed, which might be of added value in patients selection for TMVR.